[Question #5956] Followup to 5875.

17 months ago
The two tests that I took for Gono/Chlym both came back negative. 

I am about 2.5 weeks in after the rocephin/azythromycin. Symptoms have improved but I still have occasional clear discharge (nothing like it was initially)  It occurs at various times of the day when I check my underwear  after sitting down and feeling something wet when I stand...its usually a small amount on my underwear (wet spot the size of a pencil eraser). I still have a burning sensation after urination occasionally. There are also times of the day I check and my underwear is dry. 

I had a appointment with the urologist today. He said he could not tell if the discharge was normal or not when he inspected my penis. He did a dip stick test and said my urine was "clean". 

He then suggested a urethral swab after I brought up my concerns regarding Trich and M. Genetallium.  He did the swab and said he did not trust urine tests for Trich or M. Genetallium so he would send the swab out to be tested. 

I asked if he could send the urine out to test again For Gono and Chlym and he said no I would have been cured with the antibiotics. 

1. I am concerned that he did the swab literally 5 minutes after I provided the urine sample. All of my research indicates that the swab should be done 2 hours after last void. Will the swab test I took be accurate at all? I brought this up to the urologist as i was leaving. He said it didnt matter. 

2. Should I seek out a urine test for Gono/Chlym just to be sure? The tests were done on day 3 and day 4 after I believe my exposure ocurred. 

3. The rocephin and azythromycin clearly helped. I have no more yellow discharge and the amount of clear discharged has reduced about 75%. Could the discharge im seeing being normal discharge that I wouldnt normally notice? Or, could it be that my urethra is still healing 2.5 weeks and the disxharge is from the old infection? 

Thanks in advance
Edward W. Hook M.D.
Edward W. Hook M.D.
17 months ago
Welcome back to the Forum. On this occasion I happened to pick up your question and will be answering.  I have reviewed your earlier interaction with Dr. Handsfield and agree with his assessments.  Your case is a bit unusual is several ways including the lack of knowledge displayed by the first PA you saw and the fact that your discharge appears to have persisted.  The significance of your persisting discharge is difficult to say- I would have expected it to have resolved after the treatment you received and that fact that it has persisted now indicates a need to consider other pathogens (like M. genitalium and trich although like Dr. Handsfield, I would not have suggested testing for them on initial evaluation).  Another possibility is that your urethritis has been cured and is slow resolving.  Finally, my sense is that you are now on the "lookout" for any sign of infection and may be observing the small amount of discharge which may normally be present.  If I were seeing you, I probably would have repeated your gonorrhea and chlamydia tests just to be sure but the important tests are the MG and trich tests.  Judging by your urinalysis results, i think it is more likely than not that these tests will also be negative - we'll see.  

BTW, was your GF retested as her physician suggested?

In answer to your specific questions:
1.  Conventional wisdom is that better specimens are obtained when the patient has not urinated for at least on hour or two.  This was probably important with older tests.  With modern tests however, if you are infected, I anticipate the tests will show it and would believe the results.
2.  See my comment above about re-testing for gonorrhea and chlamydia.  I do not feel strongly that it is needed.
3.  Yes, as I suggested above, in your heightened state of awareness, you may be seeing normal discharge.

I hope this information helps.  I'll be interested in what your MG and trich tests show.  I anticipate they will be negative but situations such as yours are the reason we test.  EWH
16 months ago
Had my follow up with the urologist today. The Dr said the lab messed something up and I specimens were never tested. So he suggested another swab. I requested to do the urine tests instead of the swab for M. Gen and Trich to which he agreed. My girlfriend and i resumed sex about 3 weeks ago ( assuming my tests were negative) so just to be safe I requested another Gono/Chlym test again. 

My gf stated she is done with walk in clinics and wasnt able to get a appointment with her Gyn until later this month. At that time she will also be tested for the above. As of this point she hasnt noticed or told me about any symptoms. 

Im pretty sure my clear "discharge" is normal at this point. I just need to get over it. Ive found myself checking my underwear 10-15 plus times a day. I have gone entire days with seeing no wet spots at all and then days where ive seen a tiny drop 3-4 times throughout the day, mainly in the afternoon. Its highly variable and doesnt progress. I will see some one day and none a day or two later and vice versa. Still no pain or discomfort during urination.

#1. Are the NAAT urine test for M. Gen and Trich for men reliable? The urologist stated he prefers the swab but he heard there were new urine tests. 

#2. The urologist said he was testing for 3 Mycoplasma organisms. What 3 is he talking about and isnt one or two of them considered normal? Im confused as to why he would test for all of them. 

#3. Based on my above description of symptoms and the fact that they have persisted for almost 2 months, if my tests are negative, should I assume these are normal urethral secretions? Honestly if I wasnt checking I probably wouldnt even notice. The amount is so small I dont feel any wetness and they dont usually leave any stains. 

#4. The urologist thinks this could have been prostatitis or something "non infectious". The hardest part for me is Ive never experienced discharge (non stop clear discharge with occasional yellow discharge) like I did when this first started 2 months ago, when I started seeing a new partner... so STDs are the first thing to come to mind. If it was non Chlym NGU wouldnt WBCs have shown up in my urine? They did a urinalysis and urine culture while I was having discharge and everything was normal. So I guess my question is, if my tests come back negative what do you think this could have been? 

#5. My concern is im just now being tested for Trich and M gen almost 1.5 months after symptoms starting. Is it possible or likely that one of the two cured themself at this point and my test would be negative? Im a little worried i gave it to my girlfriend over the last 3 weeks and it cured itself in the meantime now a ping pong effect is going on. Either way i plan on testing the same time as her when she has her Gyn appointnment...is that would you would reccomend? 

I know some of this sounds crazy. Thanks for all you guys do. 
Edward W. Hook M.D.
Edward W. Hook M.D.
16 months ago
Straight to your follow-up questions:
1.  Many clinicians continue to favor the swab and in large studies the swab results in slightly but not significantly more positive tests.  I think the urine test should be fine.

2. I suspect he is testing for Mycoplasma genitalium, which would be a pathogen in your situation and two "normal" mycoplasmas that are not unusual to find in the male or female genital tracts, Mycoplasma hominis and Ureaplasma urealyticum.  If your test is positive for either of the latter two organisms, I would not treat them.  

3.  Yes.  Your have gotten caught in an anxiety and perhaps guilt driven spiral. If you and your GFs tests are negative, time to put these concerns aside and move forward.  

4.  Yes, part of the diagnosis of non-chlamydial NGU is inflammation, as indicated by PMNs in the urethra/urine.  I cannot not say what if might have been otherwise.  And the urologist is correct, most prostatitis is non-infectious.

5.  Yes, you and your GF should both be tested, preferably at the same time.  If one or both of you is positive for a pathogen, then you should both be treated.

Hope this helps. EWH